New-onset anosmia and ageusia in adult patients diagnosed with SARS-CoV-2 infection.

OBJECTIVES: We investigated the prevalence of anosmia and ageusia in adult patients with a laboratory-confirmed diagnosis of infection with severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). METHODS: This was a retrospective observational analysis of patients infected with SARS-CoV-2 admitted to hospital or managed in the community and their household contacts across a London population during the period March 1st to April 1st, 2020. Symptomatology and duration were extracted from routinely collected clinical data and follow-up telephone consultations. Descriptive statistics were used. RESULTS: Of 386 patients, 141 (92 community patients, 49 discharged inpatients) were included for analysis; 77/141 (55%) reported anosmia and ageusia, nine reported only ageusia and three only anosmia. The median onset of anosmia in relation to onset of SARS-CoV-2 disease (COVID-19) symptoms (as defined by the Public Health England case definition) was 4 days (interquartile range (IQR) 5). Median duration of anosmia was 8 days (IQR 16). Median duration of COVID-19 symptoms in community patients was 10 days (IQR 8) versus 18 days (IQR 13.5) in admitted patients. As of April 1, 45 patients had ongoing COVID-19 symptoms and/or anosmia; 107/141 (76%) patients had household contacts, and of 185 non-tested household contacts 79 (43%) had COVID-19 symptoms with 46/79 (58%) reporting anosmia. Six household contacts had anosmia only. CONCLUSIONS: Over half of the positive patients reported anosmia and ageusia, suggesting that these should be added to the case definition and used to guide self-isolation protocols. This adaptation may be integral to case findings in the absence of population-level testing. Until we have successful population-level vaccination coverage, these steps remain critical in the current and future waves of this pandemic.

Outcomes of inflammatory bowel disease surgery in obese versus non-obese patients: a meta-analysis.

BACKGROUND: Obesity is considered a risk factor for many chronic diseases and obese patients are often considered higher risk surgical candidates. The aim of this meta-analysis was to evaluate the outcomes of obese (body mass index ≥ 30 kg/m2) versus non-obese patients undergoing surgery for inflammatory bowel disease (IBD). METHODS: PubMed, Scopus, and Embase libraries were searched up to March 2019 for studies comparing outcomes of obese with non-obese patients undergoing surgery for IBD. A meta-analysis was conducted using Review Manager software to create forest plots and calculate odds ratios and mean differences. RESULTS: Four thousand three hundred and eleven patients from five observational studies were included. Obese patients were older at the time of surgery and more likely to have diabetes. Obese patients had longer operative times (MD 23.28, 95% CI 14.63-31.93, p < 0.001), higher intra-operative blood loss (MD 45.32, 95% CI 5.89-84.76, p = 0.02), longer length of stay (MD 0.90, 95% CI 0.60-1.20, p < 0.001), higher wound infection rates (OR 1.76, 95% CI 1.39-2.23, p < 0.001), and higher total postoperative complication rates (OR 1.33, 95% CI 1.04-1.70, p = 0.02). CONCLUSIONS: Obesity is associated with significantly worse outcomes following IBD-specific surgery, including longer operative times, greater blood loss, longer length of stay, higher wound infection rates, and higher total postoperative complication rates. Clinicians should be mindful of these increased risks when counselling patients and consider weight reduction strategies where possible.

The distribution of peripheral arterial disease in a defined population of elderly high-risk Saudi patients.

OBJECTIVES: To find out the prevalence rate of peripheral arterial disease (PAD) in a defined population of high risk Saudi patients aged 50-80 years, using simple measuring techniques. DESIGN: A hospital-based cross-sectional study using a simple protocol. MATERIALS AND METHODS: Four groups of patients were studied: three high risk groups (214 cases of diabetes (DS), 60 of chronic renal failure (CRF), 78 of ischaemic heart disease (IHD) and 50 controls. PAD was only diagnosed if the ankle-brachial index (ABI) was < or =0.9. The contribution of a history of intermittent claudication (IC) and palpation of pulses to the diagnosis was assessed. RESULTS: A total of 402 patients was studied. Their mean age was 59.31+/-8.1 (range 50-80). There were 257 males (63.9%) and 145 females (36.1%). 171 cases of PAD were detected (42.5%) and distributed among the various groups: 105 (61.4%) in the DM, 23 (13.4%) in the CRF, 36 (21.4%) in the IHD and 7 (4.1%) in the control groups. The prevalence rate was highly significant in each of the 3 high risk groups compared to the control group; however, there was no statistically significant difference in the incidence of PAD between the high risk groups. Questionnaires for IC and palpation of peripheral pulses were of very limited validity in diagnosing PAD. Overall, DM headed the list of significant risk factors followed by smoking and greater age. CONCLUSIONS: In contrast to the general impression that PAD is an uncommon disease, we found a significant prevalence rate of PAD in elderly high risk patients. Screening for PAD in aged diabetics, IHD and CRF patients is a simple and cost-effective approach.